Palliative Care Disparities for Opioid Users: Study Findings

In contrast to individuals devoid of opioid dependency, those afflicted with opioid use disorder exhibited diminished access to palliative care both within clinical settings and within the comfort of their homes. Furthermore, this demographic tended to succumb to premature mortality due to non-opioid-related causes, as revealed by recent findings published in CMAJ.

“The majority of conversations about the opioid crisis focus on the high number of opioid toxicity deaths. The unfortunate reality is that people with opioid use disorder are dying young from other causes as well. If we can improve our understanding of this population and the health care that they receive at the end of their lives, we can identify opportunities to intervene and improve their quality of life.”- Dr. Jenny Lau, author, medical director of the Harold and Shirley Lederman Palliative Care Centre at Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario

Amidst the ongoing opioid crisis, the prevalence of individuals grappling with opioid use disorder is on a relentless rise. This affliction, marked by chronicity and profound distress, poses a significant impediment to a fulfilling existence. As this demographic ages, the imperative for accessible palliative care services at life’s twilight becomes increasingly pronounced. Delving into the nuances of this predicament, the study elucidates the demographic profile of those with opioid use disorder approaching the end of their journey and scrutinizes the adequacy of palliative support they receive.

In a comprehensive analysis encompassing data from ICES pertaining to 679,840 demises, it was revealed that 11,200 individuals (1.6%) were afflicted with opioid use disorder. Notably, those ensnared by opioid dependency met their demise at a comparatively tender age of 50, in stark contrast to their counterparts without such affliction who typically lived until the age of 78. Furthermore, individuals grappling with opioid use disorder were disproportionately concentrated in marginalized communities. Regrettably, in comparison to their opioid-abstinent counterparts, this demographic faced a 16% decreased likelihood of availing themselves of palliative care services. This disparity is primarily attributed to the prevalence of sudden deaths resulting from drug poisonings within the population. Notwithstanding, among those with opioid use disorder who did receive palliative care, the most common precipitating factors included cancer, liver cirrhosis, and sepsis, underscoring the multifaceted nature of their healthcare needs.

“Although most people in Canada want to die at home, people with opioid use disorder can have limited social supports, limited finances and unstable housing, which may lead to challenges accessing palliative care in the community and challenges for health care providers to deliver this care,” says coauthor Dr. Sarina Isenberg, chair in mixed methods palliative care research at Bruyère Research Institute, and adjunct scientist, ICES, Ottawa, Ontario. “Our findings highlight the importance of health care providers receiving training in both palliative care and addictions medicine to better support patients with opioid use disorder as they near the end of life.”

For more information: Association between opioid use disorder and palliative care: a cohort study using linked health administrative data in Ontario, Canada. CMAJ, https://doi.org/10.1503/cmaj.231419